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WALGREEN CO.
CH092536AN JWCH Institute, Inc.
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Covered Entity Details
Entity Name
JWCH Institute, Inc.
Subdivision Name
Wesley Health Centers- Palmdale Central
Type
HRSA-Funded Health Center
340B ID
CH092536AN
Entity Address
2151 E Palmdale Blvd
Palmdale, CA 93550-4037
Grant Number
H80CS06673
Participating Start Date
5/2/2019
Last Recertification Date
2/19/2025
Pharmacy Details
Pharmacy Name
WALGREEN CO.
Pharmacy Address
DBA: WALGREENS #10692
1834 W AVENUE J
LANCASTER, CA 93534
Pharmacy Comments
Contract Details
Approval Date
7/5/2019
Contract Begin Date
10/1/2019
Carve-In Effective Date
Contract Comments
Contract Termination Date
Termination Reason
6/10/2020
Pharmacy closed
Contacts
Covered Entity Signing Official
ALVARO BALLESTEROS, EXECUTIVE DIRECTOR
(323) 201-4516 Ext: 3009
Contract Pharmacy Representative
Walgreens
Karl Meehan, Vice President, Health Systems Programs
(847) 315-2663
Signed By Date
7/5/2019
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